There are varying levels of protection when it comes to health care insurance policies in the United States. There has long been a push to standardize health insurance policies in order to make the base level of care the same in different parts of the country. When the Affordable Care Act was passed in 2010, a standard for basic health care was laid out for each state to follow when offering health insurance policies to residents.

Basic health care covers the cost of common health-related situations most people will have at some point in their lives. This basic care can help cover the cost of emergency room visits, management of chronic medical conditions, as well as preventative care and general checkups.

State Health Care Marketplaces

Each state is allowed to have its own health insurance marketplace that contains policies that meet both standard and Federal insurance requirements as outlined by the Affordable Care Act. Some states have chosen to default to the Federal Health Insurance Marketplace. The Affordable Care Act, or ACA, was enacted on March 23rd, 2010. Some states use the Federal health insurance structure to offer insurance policies to their residents, while other states have invested more in their health insurance structures individually.

For instance, some states have chosen to strengthen their Medicare and other cost-assisting programs to help individuals with low incomes afford basic levels of health care. Others have worked to attract local health insurance companies to the health care marketplace to expand the number of affordable health care options for residents. Whether it’s State or Federally run, an affordable, basic level of health care should be available for all residents of the United States.

Basic Health Care Coverage

Basic health care coverage, as laid out by the ACA, consist of 10 Essential Health Benefits, or EHBs. These EHBs include:

  1. Laboratory services.
  2. Emergency services.
  3. Prescription drugs.
  4. Mental health and substance use disorder services.
  5. Maternity and newborn care.
  6. Pediatric services, including oral and vision services.
  7. Rehabilitative and habilitative services and devices.
  8. Ambulatory patient services.
  9. Preventative and wellness services, chronic disease management.
  10. Hospitalization.

Basic health care consists of broad coverage that is designed to capture most peoples’ medical needs in a way that is still affordable and attainable by people around the country. Specific medical conditions, chronic medical issues, and other, more specific levels of care may raise a person’s level of health insurance need above the necessary requirements.

Basic health care plans are also rated on their actuarial value, which is the percentage that an insurance company will cover for medical bills. This means insurance will pay for the actuarial value of your medical care, while you make up the rest yourself until you meet your cost-sharing or out-of-pocket limit: the lower the actuarial value, the more basic the plan. Under the ACA, health insurance plans must have at least a 60% actuarial value to meet the minimum standards for a basic health care policy.

There are five health care levels on State and Federal Health Care Marketplace. They include:

  •      Platinum
  •      Gold
  •      Silver
  •      Bronze
  •      Catastrophic

What Health Care Doesn’t Qualify as Basic?

In 2019, individuals with health insurance policies that don’t meet the basic minimum essential coverage requirements won’t be forced to pay the penalty. Prior to 2019, individuals who didn’t have health insurance at a basic level were financially penalized.

Additionally, some people may have renewed health insurance policies as they had before March 23rd, 2010 when the ACA came into effect. These health insurance policies may be grandfathered in without a penalty being levied on the policyholder. These policies may not offer a basic level of health care, and their coverage might not meet the ACA’s minimum essential coverage.

Here are more examples of health care that wouldn’t be considered a basic level of coverage:

  •      An insurance policy that only covers vision or dental care.
  •      A workers’ compensation policy.
  •      Coverage for a specific medical disease or condition.
  •      Insurance plans that only offer discounts for medical services.
  •      An insurance policy with an actuarial value of less than 60%.

To learn more about basic health care requirements and changes to the ACA, contact the professionals with at 1-855-881-0430. Our licensed insurance experts will be happy to answer any questions you have.